Middle and outer ear trigger Flashcards by Billie Roberts

Pseudomonas is the MCC of which ear problems

diffuse AOE “swimmers ear”
Malignant/necrotizing COE
Chronic suppurative OM
perichondritis (+staph Aureus)

How well did you know this?

Not at all

Perfectly

Staph Aureus is the MCC of which ear problems

Perichondritis (+psuedomonas)
Auricular Cellulitis ( + strep)
Localized AOE furunculosis

How well did you know this?

Not at all

Perfectly

can be caused by overcleaning ear

diffuse AOE swimmers ear

How well did you know this?

Not at all

Perfectly

itching, severe pain, conductive hearing loss and sense of fullness/pressure

diffuse AOE swimmers ear

How well did you know this?

Not at all

Perfectly

erythematous canal, otorrhea, difficulty visualizing TM, moist debris present in canal

diffuse AOE swimmers ear

also see:
pain upon tragus palpation or auricle retraction

How well did you know this?

Not at all

Perfectly

pain upon tragus palpation or auricle retraction

diffuse AOE swimmers ear

also see:
erythematous canal, otorrhea, difficulty visualizing TM, moist debris present in canal

How well did you know this?

Not at all

Perfectly

topical ofloxacin/ciprofloxacin or cortisporin. If severe oral cipro and/or steroids.

diffuse AOE swimmers ear

How well did you know this?

Not at all

Perfectly

Treated with dicloxacillin or keflex

localized AOE furunculosis

How well did you know this?

Not at all

Perfectly

caused by aspergillosis

COE otomycosis

can also be caused by candidiases

How well did you know this?

Not at all

Perfectly

risk factor is previous use of antibiotics in ear

COE otomycosis

risk factor is also hot/humid

How well did you know this?

Not at all

Perfectly

deep seated itching, discomfort and discharge

COE otomycosis

also presents with:
mild pain
soft/white mold in ear

How well did you know this?

Not at all

Perfectly

treated with clotrimazole 1% solution

COE otomycosis

How well did you know this?

Not at all

Perfectly

can be caused by Seborrhic dermatitis or contact dermatitis

Non-infective COE

also caused by psoriasis

How well did you know this?

Not at all

Perfectly

can be caused by psoriasis

non-infective COE

also by: contact or seborrhic dermatitis

How well did you know this?

Not at all

Perfectly

presents as red, scaly, dry skin

non-infective COE

How well did you know this?

Not at all

Perfectly

treated with topical or otic hydrocortisone

non-infective COE

How well did you know this?

Not at all

Perfectly

pts who are immunocompromised or elderly are at higher risk for this ear disease

necrotizing otitis externa

How well did you know this?

Not at all

Perfectly

this ear problem can spread to the base of the skull potentially causing osteomyelitis

necrotizing otitis externa

How well did you know this?

Not at all

Perfectly

deep seated pain disproportionate to exam findings

necrotizing otitis externa

How well did you know this?

Not at all

Perfectly

purulent otorrhea with temporal HA

necrotizing otitis externa

How well did you know this?

Not at all

Perfectly

granulation tissue at bony cartilaginous junction of ear canal floor

necrotizing otitis externa

How well did you know this?

Not at all

Perfectly

must obtain CT scan to evaluate

necrotizing otitis externa

also need tissue biopsy

CT scan is also used to evaluate mastoiditis so that is also correct!

How well did you know this?

Not at all

Perfectly

must obtain tissue biospy to evaluate

necrotizing otitis externa

must also get a CT scan

How well did you know this?

Not at all

Perfectly

aggressive glycemic control as tx

necrotizing otitis externa

also use:
IV cipro
followed by oral cipro
with surgical debridement if severe/refractory

How well did you know this?

Not at all

Perfectly

when is IV cipro indicated

necrotizing otitis externa followed by oral cipro also use glycemic control can also be used in perichondritis

Gallium nuclear scan is used for what

necrotizing otitis externa. Only when no more inflammation is seen on this scan can you stop the cipro

geniculate ganglion infection

herpes zoster oticus

vascular rash

herpes zoster oticus

can be mistaken as bells palsy

herpes zoster oticus

severe otalgia and facial palsy

herpes zoster oticus aka ramsay hunt

treat with prednisone in tandem to another med.... what is the diagnosis? what is the other med?

sorry i know this was rude but it would have given it away Dx: Herpes Zoster Oticus Tx: prednisone + famciclovir or valcyclovir note: if you said AOE or auditory eustachian tube dysfunction you are technically not wrong cuz these are treated with steroids!

what ear problems can be caused by overcleaning the ear

cerumen impaction swimmers ear

when do we see 3% h2o2 and detergent ear drops such as debrox and cerumex

at home cerumen impaction removal

warm moist environmens cause increased risk of what types of ear problems

swimmers ear otomycosis

what problems involve the perichondria

auricle hematoma: collection of blood under perichondria Perichondritis: infection of perichondrium

often a result of trauma (there are multiple)

auricle hematoma auricular cellulitis perichondritis

direct trauma to anterior auricle

auricle hematoma

How do you treat an auricle hematoma?

* 7 days of onset to prevent cosmetic damage. * Lidocaine 1% (4 locations, stick twice) * I&D * NS Irrigation * Compression Dressing for 7 days (check daily) * ABX prophylaxis (maybe)

avoid NSAID use

auricle hematoma

What nerves must be blocked for a complete auricle block?

* Lesser occipital nerve * Greater auricular nerve * Auriculotemporal nerve

assess for basilar skull fracture, TM and canal damage as well as the function of the facial nerve. may also want to check for hearing deficits

things we need to check with auricular lacerations

primary closure with interrupted sutures

auricular laceration

MC organisms for this include Staph Aureus and strep

auricular cellulitis

Treat with Keflex, bactrim or clinda

auricular cellulitis

IV vanc

auricular cellulitis when presenting with: tachycardia rapid progression of erythema progressing of s/s despite abx systemic toxicity (fever >100.5)

tachycardia, rapid progression of erythema, progressing of s/s despite abx, or systemic toxicity (fever >100.5)

auricular cellulitis needing to be treated with IV vanc

caused by MC pseudomonas and S aureus

perichondritis

MC reason for childhood ABX use.

AOM

this bacteria causes AOM in older children with more local complications

group A strep

this bacteria causes acute otorrhea in children with tympanostomy tubes

staph

this bacteria is MCC of AOM in the first few months of life

E coli

this bacteria is the cause of chronic, suppurative OM

pseudomonas

this bacteria is MC of AOM in infants younger than 2 weeks

Group B strep

Negative pressure followed by accumulation of secretions can cause

AOM

URI is the MC preceeding factor of what disease

AOM

Bulging of TM, Poor mobility of TM with erythema present.

AOM

Suppurative opacities in TM, decreased/absent mobility, otorrhea

OM with effusion

S. pneumo, M cat, H flu

3 MCC of AOM

otalgia, hearing loss, present with non specific sympotms such as fever, HA, NVD, irritability, congestion ect

AOM

AOM mild-mod tx, consider pcn allergy as well

amoxicillin 1st line if not: omnicef cefuroxime azithromycin

why do we not prefer to use azithromycin

lacks acitivyt against most H flu and 1/3 of pneumococcal isolates

If a patient has AOM and has had ABX within the last 30 days what is tx consider pcn allergy as well

amoxicillin + augmentin 1st then: omnicef rocephin clinda

what is given to patients with AOM who have a immediate anaphylactic response to PCN

azithromax or docycycline

What qualifies as severe AOM?

Significant hearing loss Severe pain Fever > 102F Immunocompromised Under 6mo of age Marked TM erythema

How do you treat severe AOM or AOM w/ associated bacterial conjunctivitis?

Augmentin OR Rocephin

How do you treat severe AOM or AOM w/ associated bacterial conjunctivitis in a patient who has been exposed to abx in the past 30 days or has treatment failure

rocephin clinda consider tympanocentesis

smoking/second hand smoke as risk factor

AOM

lack of breastfeeding as risk factor

AOM

when should children stop using a pacifier

10 months old

what is treated with the same medications as AOM with the addition of Zithromax to cover mycoplasma

bullous myringitis

sudden decrease in otalgia and sudden development of otorrhea

TM rupture

Tx for TM rupture

1st - Amoxicillin augmentin cefdinir can also use olfoxacin or ciprodex as a topical

what are low ototoxicity topical antibiotics

ofloxacin and ciprodex

pseudomonas, proteus, s aureus

Chronic OM

Topical tx: ofloxacin/cipro with dexamethasone for exacerbations

Chronic OM can also be tx with oral cipro

Definitive tx is surgical repair with temporalis muscle fascia

Chronic OM

Abnormal growth of squamous epithelium in middle ear or mastoid

cholesteatoma

concerns with this ear complication includes destruction of auditory ossicles

cholesteatoma

deep retraction pockets with white mass behind TM

cholesteatoma also see: focal granulation at TM periphery ear drainage >2 weeks despite tx conductive hearing loss

focal granulation at TM periphery ear drainage >2 weeks despite tx conductive hearing loss

cholesteatoma also see: deep retraction pockets and white mass behind TM

treated with surgical debridement

cholesteatoma also necrotizing COE if refractory to pharm tx

Pus filling mastoid air cells, leading to bone erosion and cavity formation

mastoiditis

proptosis of ear with fever

mastoiditis

diagnosed via CT scan

mastoiditis

Tx for mastoiditis

* IV antibiotics for 7-10 days (use rocephin or cefazolin) * followed by oral ABX (augmentin or cefdinir) * followed by myringotomy * if this tx plan fails then consider mastoidectomy and debridement

Systemic/IN decongestants

eustachian tube dysfunction or barotrauma

intranasal steroids

eustachian tube dysfunction when due to allergies

Hemotympanum

complication of barotrauma

Perilymphatic fistula

complication of barotrauma

Bony overgrowths of the ear canal

exostoses/osteomas

repeated exposure to cold water is a risk factor for

multiple exostoses must be treated w surgery

What is the MCC of neoplasia of the ear canal?

squamous cell carcinoma